Dr. Hart sat down with me in his office at Columbia University to discuss some conclusions he has reached about the facts of drug use and effects, and the politically expedient stories we have been taught to believe.
One of the things that became apparent is that this whole notion of a crack epidemic, there simply was no evidence for it.
I understand that you came into the field of drug research because you wanted to find out what was going on, with all the media reports of this scourge on the black community, and then things took a very different turn. I would like to hear a little bit about how that journey occurred.
Well I think most of us bought into it. It was in the 80’s where you had the whole crack thing. President Reagan and Nancy, they said that we had this “crack epidemic” going on. And then there were people in the community who were blaming crack cocaine for a wide range of problems: lack of employment, crime, all of these sorts of things, crack was being blamed for. And then all my favorite artists were also buying into this sort of thing – Gil Scott Heron, Public Enemy, and movies – New Jack City, Spike Lee did some films. All of these people were my favorite artists and they were important in helping me learn how to think. The Congressional Black Caucus, they all bought into this. They signed onto the 1986 laws that punished crack 100 times more harshly than powder. And so, when you have that sort of situation, it’s like, well, all these people can’t be wrong. I admire and respect these people. So I thought that one of the ways I could contribute is to learn more about drug addiction and try and help people with their drug addiction. You solve drug addiction, you solve the drug problem, and then you solve unemployment issues, you solve issues of violence and crime. So I thought.
And in the process of learning, one of the things that became apparent is that this whole notion of a crack epidemic, there simply was no evidence for it. Use of crack cocaine was always relatively low compared to powder cocaine, compared to marijuana, compared to other drug use. So that was inconsistent. And then other things that were inconsistent were “one hit and you’re addicted.” Just not true. We found that out through research studies that we did and also that other people did. All of these things started to challenge my thinking, and so I started to really question our entire field. And after reading historical accounts, newspapers about what people said about cocaine and other drugs, previously, then you start to see that this isn’t so much about the drugs, it’s about going after groups that we don’t like. And then you start to look at the racial discrimination and the data in terms of who is being arrested for what. So when I started to see all this stuff come together, I was actually angry, because I felt like a fraud had been perpetrated against me. But I didn’t know how to do anything about it. Because at this point, I was steeped in science, steeped into trying to be a tenured faculty at an institution. And if you’re trying to do that, you have to publish, and play the game. And part of playing the game, I learned, is that you publish these findings that say, “Drugs are bad.” That’s part of playing the game, because then it’s easier to get your papers published, if drugs are bad. And you certainly can’t say drugs have these good effects. So I was kind of trapped. I didn’t know what to do. Then I figured out I could publish review papers of the literature that other people had done. And then when you publish review papers you can publish critical reviews. And you can start pointing out that the data doesn’t follow the conclusions, and so I started slowly raising questions within an appropriate science mechanism. And then once I started doing that, I was asked to do a book, and I was tenured at this time, and that then provided the perfect vehicle to really say what the data say, and to point out the hypocrisy.
But, in this country, we are allowed to have these baseless ideas and policies when they deleteriously affect groups that we don’t care about.
When you did get this opportunity to write a book, why did you decide to integrate memoir?
Well one of the things that I know is that I have written damn near a hundred science articles, and maybe three people have read them. They’re boring. And in science, we try not to interject our personal feelings into what we write. But that’s deceptive. Because we do it all the time, but we pretend that we don’t. So it’s more dishonest than anything. But that dishonesty decreases the likelihood that anybody outside your field will read what you write. So I decided to use memoir for multiple reasons. I was thinking about who I was really trying to reach. I was trying to be clear that I was writing a book about the young cats, the brothers and sisters who look like me and came from communities where I came from. That was my audience, and I was very clear about that. But I knew if I wrote it well enough, it would have universal appeal. And then when you talk about that target audience, there are few books that are written for them. And so, in order to write a book for them you have to make a connection. And if they knew where I came from and how I came up, I thought that would connect, and they could see themselves in my story, and they could learn something about critical thinking, and not even realize they’re learning about critical thinking. I know anecdotes are powerful, but they are not data, I know that too. So I had to make sure I backed up the anecdote with data. That’s the major reason, to make the connection with these people who look like me, and who books aren’t usually written for.
And what you wanted to communicate was in part that this so-called “crack epidemic” was primarily institutionalized racism and not actually based in fact? And what was really going on was…
Crack was just part of it, that’s some of it because I did some crack cocaine research. But it’s a lot larger than crack cocaine. Certainly I talk a lot about methamphetamine, and I talk a little bit about keeping people safe with drugs, and I talk a lot about neuroscience and how they’ve been manipulated to believe some of these things. But the larger sort of thing is that in the United States we have perpetrated a lot of racial discrimination and we’re not honest about it. And so I was trying to look at the bigger picture, and drugs were just used as a vehicle to get me to talk about racial discrimination, to talk about poverty, the deflection of the federal government to really deal with issues. I’m a drug expert so it gave me a way in to talk about these larger issues, but the most important thing in the book for me are those larger issues, and crack was just one of those situations where it’s a myth that you destroy right up front, and if you bust that myth, now you’ve got people willing to listen for a lot of things, and so, again, it just became a vehicle.
Could you talk a little bit about this mythology that crack versus powder cocaine is so much more powerful, and so much more addictive, and how you have contributed to busting up that myth?
When you look at the chemical structure of powder cocaine and crack cocaine, the only difference is that the powder cocaine has the hydrochloride portion attached to it. They both have the cocaine base, and the pharmacological activity is in the base, not the hydrochloride salt. The hydrochloride salt is there just to make it stable such that the drug can’t be smoked. That’s the only difference. And so what you’re really talking about is a route of administration difference, but people didn’t realize that, and so that’s where I started from. And then you look at all the data that compare the effects of intravenous cocaine to smoked cocaine. The time course, intensity of effects, all the same. Same drug, same effect. So when you just step back and look at the data, you realize that the hysteria is not based on data, it’s just some great stories that people make up.
And yet the severity of punishment for crack versus powder, you write, is now 18:1, and was 100:1 in the 1990s.
That’s right. It was 1986-1988, the laws passed were 100:1, and in 2010, like you pointed out, Barack Obama signed legislation to make it 18:1, such that crack is punished 18 times more harshly than powder, which is fucking stupid. So that just goes to show that we’re still stupid, even when we get a president that people voted for because he said that he would get rid of this difference. He didn’t. Most politicians are cowards, and they don’t have the political guts to do the right thing, and we see this now.
Because what would happen?
I don’t know what would happen. I really don’t care. It’s not justice. Maybe somebody would say, “You’re being soft on crime.” That’s some stupid shit. But that’s what we say, a lot. The thing is that the people who voted for the president should put pressure on him to change, because politicians will not make changes if there is no pressure. This is one of the most frustrating things to me, because it’s so clear. I ask people to think about if we punished people who were caught smoking marijuana more harshly than people who were caught putting marijuana in their brownies. It’s ridiculous. It’s the same sort of thing. But, in this country, we are allowed to have these baseless ideas and policies when they deleteriously affect groups that we don’t care about. We’re doing this interview in the backdrop of the cat who was killed on Staten Island over the weekend, the guy who was choked by the police. There’s a video, in which the police choke a black guy [Eric Garner] who they don’t even seem to have a reason to arrest, put a[n illegal] chokehold and they kill him. And so you see these kinds of things happening too frequently, and then society does nothing. So it’s the same sort of thing with the whole crack thing. Black people still represent more than 80 percent of the people arrested for crack and prosecuted at the federal level and under these laws. We still have this differential treatment.
Yeah, about 80-90% of the people that use drugs do so safely. They go to work, they pay their taxes, they take care of their families, and in some cases they even become president.
Yet most of the people who are using crack are white, in fact.
That’s right, that’s exactly right.
You made a comparison between the discussion about crack cocaine in the 80s and methamphetamine today, and the hyperbole around it, and the analogy that the methamphetamine users are purportedly rural, gay, and poor, which comprise several oppressed groups, and so it’s quite easy to attack them as well.
Absolutely. This is one of the things we use drug policy for, because it’s not cool in our society to say, “we don’t like gay people.” We can’t say that we don’t like poor, white people. But we can say that we don’t like some behavior that’s primarily associated with them, even though they don’t make up the majority of the users, that’s a fact, but we can put our law enforcement resources in their communities and say, they’re the people causing the problem. Their drug use is causing the problem, so we’re going after their drug use. But really, we’re going after them. And nobody really cares about poor white people. Nobody really cares about gay people. And so, when that happens, you can’t say you’re going after gay people, but you can say you’re going after this awful activity. “Methamphetamine is such a horrible drug.” It’s not, as you read in the book, it’s the same drug as Adderall, but you can say that it’s a horrible drug, it’s caused all these problems, and in the process, arrest all these people we don’t like.
You point out that 90% of people that use drugs do not become drug addicts.
Yeah, about 80-90% of the people that use drugs do so safely. They go to work, they pay their taxes, they take care of their families, and in some cases they even become president. So, yeah, that’s a number that people don’t think about, and some people just don’t know. But it’s a fact, and we’ve been collecting these data for more than forty years and we’ve known this.
I have to ask you about your experiments.
The one that people like to ask about is the one where we offer money versus drugs. Those experiments grew out of the animal experiments, because when I was an undergraduate, people told us that if you allow an animal to self-administer a drug like cocaine or methamphetamine it would do so until it died. And then you can see the papers that people wrote and these animals actually did: primates, rats – they self-administered these drugs until death. But it wasn’t the whole story. When you look at the cages of those animals, the only thing that was there was a lever that led to drug administration. When you put other things in the cages of those animals, like a sexually receptive mate, a sweet treat, toys, or anything else, the animals wouldn’t self-administer the drugs until death. And in fact they engaged in those non-drug alternative behaviors a lot more than the drugs, in some cases. And so one of the things we thought would be interesting was to offer people non-drug alternatives, being money. And with the first experiments we offered something as low as five dollars or a hit of crack that’s worth more than five dollars, multiple times. And what you found was that these folks took crack on about half of the occasions and the money on the other half of the occasions.
When you increased the amount of money to something like $20, they almost never took the drug, they always took the money. That told us that drug-taking behavior, even in drug addicts, was sensitive to the availability of alternatives. If you provided alternatives, you could decrease drug-taking behavior. Now, that provided some clue about treatment for some people. For some people, they just didn’t have the proper amount of alternative reinforcers. Not for everyone of course, because some people might be addicted because they have co-occurring psychiatric disorders like depression, anxiety, schizophrenia, and you’ve got to treat those sorts of things, and other people, they may have just an inability to temper their behavior in multiple domains, and they just need to learn some better skills. But, for the sort of people where alternatives seem to be important, it was an important finding. It also told us that crack and methamphetamine were not so addictive that they would do anything to get a hit, like people had been saying. So those experiments were very important, and I think that the experiments told us what many people already knew—I’ve talked to several drug dealers and those kind of people, these days, and they’re like, “You opened my eyes in that it made me think about the people who bought drugs from me. You know, of course many of them had jobs, and they were doing their business.” But they said they never really focused on them. Of course, how else are you going to be able to buy drugs if you don’t have a job? Yeah, of course, there are people who don’t have jobs and they have other ways of getting money, but the majority of those people, they have jobs.
Can you tell me a little about “contingency management,” which you talk about as an effective way to combat drug addiction?
Contingency management grew out of those experiments that I described where you offer alternatives. What contingency management does is that it pays people a certain amount of money to submit drug-free urines. So, if you’re in treatment, and you come to a clinic, you submit drug-free urine, then you get $2.50 for that day. And then that may be escalated over time. The next day you come it might be $5, the next day $7.50. Contingency management has been shown to decrease cocaine use and all the rest of these sorts of things. The problem is when you take away the contingency, the money, sometimes the drug use returns. So what people have done is they have used these contingencies in different ways. So you not only are paying people for drug-free urines, but you’re training them, and you’re paying them for skills they acquire, data-entry skills for instance, skills that they can now trade in for a job. And so that seems to work a lot more effectively – when you train people with an employable skill, that seems to work. There is some work out of Johns Hopkins that Ken Silverman and his group have done that’s been incredible using these contingency management techniques. It’s just what we do with our children. When our children do well in school, they may get a toy that they want, or a video game, or something that they want which is shaping up these behaviors, in the same way that Ken Silverman is shaping up job-training skills. All of these things we do with our kids, but some people don’t have the resources to access – like me, I’m a middle class person, I could do this with my kid, but some people, certainly when I was growing up, my parents didn’t have that sort of access. It’s just basic logic; it’s what we all do anyway.
And we don’t put our kids in jail for bringing home C minuses, which is the alternative, quite often, when it comes to drug policy.
Yeah, we certainly do that, in terms of drugs. The thing is though, we don’t put all of our kids in jail, we put some kids in jail, the kids we don’t like, those are the ones who go to jail. That’s a problem, that’s one of the things I argue in the book, that we should decriminalize all drug possessions. I argue that because it just doesn’t seem to make any sense that we are arresting all of these people for these minor drug infractions. But arresting these people has created a large number of jobs for certain people in our society. And politicians look like they are doing their jobs. So a lot of people are benefiting from having these types of laws.
You say addiction is not an equal opportunity affliction, in that it affects the poor with more frequency than it does the middle class or the rich because the poor have fewer opportunities. That runs counter to my experience. If you have more money, maybe it just makes you better able to get by, to lessen the repercussions, so that there may be just as many rich drug addicts as poor.
Well, no, you just hit it. The major thing I’m talking about are the consequences, what you just said. The fact is wealth can protect you from a number of things. You have heart disease. We all can get heart disease, but if you’re wealthy, you can deal with it better and the consequences can be not as severe as for poor people. Poor people die more often from HIV-related illnesses, not because they are more physically susceptible, but because they have limited resources to deal with it. The same is true of drug addiction. That’s all. I’m not saying that poor people are more likely to become drug addicts, but they are certainly more likely to have the negative consequences happen as a result of their drug addiction.
The last question I have is that I thought it was really interesting when you were talking about “set and setting,” the phrase popularized by Timothy Leary, about how drug effects are not determined just by their pharmacology, but by all the things that are going on in the environment. I was wondering if you could talk about that and its implications for the wider political sphere.
So, “set and setting.” First of all, people understand this easily when you think about alcohol - if you give the same alcoholic beverage to someone who doesn’t drink at all, you’ll see different effects, simply because one person is tolerant versus the other. We all get that. That is “the set.” The same is true with heroin, the same is true with cocaine: if you’ve got somebody who uses the drug on a more regular basis versus somebody who doesn’t. Marijuana - you know, someone can smoke a lot of weed, and they’re getting nice and blasted on their weed, but you give the same amount to some inexperienced person, you might see some paranoia, some anxiety, a wide range of negative effects. But that’s all about set. And so people should be cognizant of that. If you’re aware of that sort of thing, if you’re getting high with someone who’s more experienced, you don’t try and hang out, don't try to do the same amount as them, that’s stupid. And so you want to make sure people understand that you start off slowly. Crawl before you walk, that’s all that is. Setting. Setting is so important because if you’re using these psychoactive drugs, which are potentially dangerous, and they’re powerful, they can be at the right doses, if you’re getting high in a situation that is anxiety-provoking, uncomfortable, and you’ve taken a nice, large dose, that’s not good. You’re setting yourself up, particularly if you’re getting high with people you don’t know, you don’t trust. That’s a horrible situation. So you want people to understand that if you are getting intoxicated with any of these drugs, that you do it in a comfortable setting with people you trust. It changes the experience radically, and that has little to do with pharmacology itself, it has more to do with set and setting, and if people understood those things, they would have a better time.